Physiotherapist Factors Associated With the Intention to Deliver Psychologically Informed Physiotherapy in Persistent Low Back Pain: An Online Cross-sectional Vignette Study

Abstract

Background: Prior qualitative research has revealed several barriers to physiotherapists delivering psychologically informed physiotherapy (PIP). It is not known which factors are most relevant to PIP delivery.

Objectives: To determine the proportion of physiotherapists in Aotearoa/New Zealand who intend to deliver PIP to persons with non-specific low back pain (LBP), and to determine factors associated with the intention to deliver PIP.

Design: This study used a cross-sectional online vignette case survey design. Setting Aotearoa/New Zealand registered physiotherapists who regularly treat LBP were invited to participate.

Methods: Participants (n=224) outlined their intended assessment and treatment plan for two vignettes with persistent LBP. They then completed the Knowledge and Attitudes of Pain Questionnaire (KNAP), components of the Determinants of Implementation Behaviour Questionnaire (DIBQ) and demographic questions. The proportion of physiotherapists intending to deliver PIP was determined by scoring participants’ vignette plans as psychologically informed or non-psychologically informed. Binary regression was used to determine which questionnaire and demographic variables were associated with the intention to deliver PIP.

Results: One third of participants intended to deliver PIP in the management of LBP. Binary regression analysis showed that pain knowledge and attitudes were consistently associated with the intention to deliver PIP across vignettes (OR=1.05, 95% CI=1.01 – 1.08; p=.015) (OR=1.05, 95% CI=1.02 – 1.09, p=.005). Beliefs about the consequences of PIP was associated with the intention to deliver PIP in one vignette (OR=2.15, 95% CI=1.12 – 4.11, p=.021).

Conclusion: Findings suggest that physiotherapists’ knowledge and attitudes towards pain and their belief that PIP is effective are associated with PIP delivery. Improving pain knowledge and beliefs around PIP may improve the quality of LBP management.